|
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: AlohaCare Medicaid |
$2.13
|
| Rate for Payer: AlohaCare Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Devoted Health Medicare |
$4.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.05
|
| Rate for Payer: Health Management Network Commercial |
$3.62
|
| Rate for Payer: Humana Medicare |
$3.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$4.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.83
|
| Rate for Payer: University Health Alliance Commercial |
$3.11
|
|
|
HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Health Management Network Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$4.13
|
|
|
HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML PO SU12
|
Facility
|
OP
|
$18.47
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$18.29 |
| Rate for Payer: AlohaCare Medicaid |
$9.23
|
| Rate for Payer: AlohaCare Medicare |
$16.62
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Devoted Health Medicare |
$18.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.55
|
| Rate for Payer: Health Management Network Commercial |
$15.70
|
| Rate for Payer: Humana Medicare |
$16.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.62
|
| Rate for Payer: MDX Hawaii PPO |
$17.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.62
|
| Rate for Payer: University Health Alliance Commercial |
$13.46
|
|
|
HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML PO SU12
|
Facility
|
IP
|
$18.47
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Health Management Network Commercial |
$15.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.62
|
| Rate for Payer: MDX Hawaii PPO |
$17.92
|
|
|
HYDROCORTISONE 10 MG PO TABLET
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: AlohaCare Medicaid |
$4.96
|
| Rate for Payer: AlohaCare Medicaid |
$5.53
|
| Rate for Payer: AlohaCare Medicaid |
$1.58
|
| Rate for Payer: AlohaCare Medicare |
$9.95
|
| Rate for Payer: AlohaCare Medicare |
$8.92
|
| Rate for Payer: AlohaCare Medicare |
$2.85
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Devoted Health Medicare |
$3.14
|
| Rate for Payer: Devoted Health Medicare |
$10.94
|
| Rate for Payer: Devoted Health Medicare |
$9.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network Commercial |
$9.39
|
| Rate for Payer: Health Management Network Commercial |
$8.42
|
| Rate for Payer: Health Management Network Commercial |
$2.69
|
| Rate for Payer: Humana Medicare |
$9.95
|
| Rate for Payer: Humana Medicare |
$2.85
|
| Rate for Payer: Humana Medicare |
$8.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.85
|
| Rate for Payer: MDX Hawaii PPO |
$9.61
|
| Rate for Payer: MDX Hawaii PPO |
$3.07
|
| Rate for Payer: MDX Hawaii PPO |
$10.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.95
|
| Rate for Payer: University Health Alliance Commercial |
$7.22
|
| Rate for Payer: University Health Alliance Commercial |
$8.05
|
| Rate for Payer: University Health Alliance Commercial |
$2.31
|
|
|
HYDROCORTISONE 10 MG PO TABLET
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Health Management Network Commercial |
$8.42
|
| Rate for Payer: Health Management Network Commercial |
$9.39
|
| Rate for Payer: Health Management Network Commercial |
$2.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.92
|
| Rate for Payer: MDX Hawaii PPO |
$3.07
|
| Rate for Payer: MDX Hawaii PPO |
$10.72
|
| Rate for Payer: MDX Hawaii PPO |
$9.61
|
|
|
HYDROCORTISONE 1 % TOP CR
|
Facility
|
OP
|
$22.11
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: AlohaCare Medicaid |
$11.05
|
| Rate for Payer: AlohaCare Medicare |
$19.90
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Devoted Health Medicare |
$21.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network Commercial |
$18.79
|
| Rate for Payer: Humana Medicare |
$19.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.90
|
| Rate for Payer: MDX Hawaii PPO |
$21.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.90
|
| Rate for Payer: University Health Alliance Commercial |
$16.12
|
|
|
HYDROCORTISONE 1 % TOP CR
|
Facility
|
IP
|
$22.11
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Health Management Network Commercial |
$18.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.90
|
| Rate for Payer: MDX Hawaii PPO |
$21.45
|
|
|
HYDROCORTISONE 2.5 % TOP CR
|
Facility
|
OP
|
$56.36
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: AlohaCare Medicaid |
$28.18
|
| Rate for Payer: AlohaCare Medicaid |
$9.11
|
| Rate for Payer: AlohaCare Medicare |
$16.40
|
| Rate for Payer: AlohaCare Medicare |
$50.72
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$36.63
|
| Rate for Payer: Devoted Health Medicare |
$55.80
|
| Rate for Payer: Devoted Health Medicare |
$18.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.54
|
| Rate for Payer: Health Management Network Commercial |
$47.91
|
| Rate for Payer: Health Management Network Commercial |
$15.49
|
| Rate for Payer: Humana Medicare |
$50.72
|
| Rate for Payer: Humana Medicare |
$16.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.72
|
| Rate for Payer: MDX Hawaii PPO |
$17.67
|
| Rate for Payer: MDX Hawaii PPO |
$54.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.40
|
| Rate for Payer: University Health Alliance Commercial |
$41.08
|
| Rate for Payer: University Health Alliance Commercial |
$13.28
|
|
|
HYDROCORTISONE 2.5 % TOP CR
|
Facility
|
IP
|
$18.22
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$36.63
|
| Rate for Payer: Health Management Network Commercial |
$15.49
|
| Rate for Payer: Health Management Network Commercial |
$47.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.72
|
| Rate for Payer: MDX Hawaii PPO |
$54.67
|
| Rate for Payer: MDX Hawaii PPO |
$17.67
|
|
|
HYDROCORTISONE ACETATE 25 MG PR SUPP
|
Facility
|
IP
|
$327.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.33 |
| Max. Negotiated Rate |
$317.63 |
| Rate for Payer: Cash Price |
$212.84
|
| Rate for Payer: Health Management Network Commercial |
$278.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.70
|
| Rate for Payer: MDX Hawaii PPO |
$317.63
|
|
|
HYDROCORTISONE ACETATE 25 MG PR SUPP
|
Facility
|
OP
|
$327.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.72 |
| Max. Negotiated Rate |
$324.18 |
| Rate for Payer: AlohaCare Medicaid |
$163.72
|
| Rate for Payer: AlohaCare Medicare |
$294.70
|
| Rate for Payer: Cash Price |
$212.84
|
| Rate for Payer: Devoted Health Medicare |
$324.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$294.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$311.08
|
| Rate for Payer: Health Management Network Commercial |
$278.33
|
| Rate for Payer: Humana Medicare |
$294.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.70
|
| Rate for Payer: MDX Hawaii PPO |
$317.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$294.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$294.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$294.70
|
| Rate for Payer: University Health Alliance Commercial |
$238.68
|
|
|
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ RECON.SOLN.
|
Facility
|
OP
|
$64.97
|
|
|
Service Code
|
HCPCS J1720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: AlohaCare Medicaid |
$32.48
|
| Rate for Payer: AlohaCare Medicaid |
$57.91
|
| Rate for Payer: AlohaCare Medicare |
$104.23
|
| Rate for Payer: AlohaCare Medicare |
$58.47
|
| Rate for Payer: Cash Price |
$42.23
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Cash Price |
$42.23
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Devoted Health Medicare |
$114.65
|
| Rate for Payer: Devoted Health Medicare |
$64.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.72
|
| Rate for Payer: Health Management Network Commercial |
$55.22
|
| Rate for Payer: Health Management Network Commercial |
$98.44
|
| Rate for Payer: Humana Medicare |
$58.47
|
| Rate for Payer: Humana Medicare |
$104.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.47
|
| Rate for Payer: MDX Hawaii PPO |
$63.02
|
| Rate for Payer: MDX Hawaii PPO |
$112.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.23
|
| Rate for Payer: University Health Alliance Commercial |
$47.36
|
| Rate for Payer: University Health Alliance Commercial |
$84.41
|
|
|
HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ RECON.SOLN.
|
Facility
|
IP
|
$64.97
|
|
|
Service Code
|
HCPCS J1720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$63.02 |
| Rate for Payer: Cash Price |
$42.23
|
| Rate for Payer: Cash Price |
$75.28
|
| Rate for Payer: Health Management Network Commercial |
$55.22
|
| Rate for Payer: Health Management Network Commercial |
$98.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.47
|
| Rate for Payer: MDX Hawaii PPO |
$112.34
|
| Rate for Payer: MDX Hawaii PPO |
$63.02
|
|
|
HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ RECON.SOLN.
|
Facility
|
OP
|
$120.17
|
|
|
Service Code
|
HCPCS J1720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$118.97 |
| Rate for Payer: AlohaCare Medicaid |
$60.09
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$78.11
|
| Rate for Payer: Cash Price |
$78.11
|
| Rate for Payer: Devoted Health Medicare |
$118.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$114.16
|
| Rate for Payer: Health Management Network Commercial |
$102.14
|
| Rate for Payer: Humana Medicare |
$108.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.15
|
| Rate for Payer: MDX Hawaii PPO |
$116.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.15
|
| Rate for Payer: University Health Alliance Commercial |
$87.59
|
|
|
HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ RECON.SOLN.
|
Facility
|
IP
|
$120.17
|
|
|
Service Code
|
HCPCS J1720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.14 |
| Max. Negotiated Rate |
$116.56 |
| Rate for Payer: Cash Price |
$78.11
|
| Rate for Payer: Health Management Network Commercial |
$102.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.15
|
| Rate for Payer: MDX Hawaii PPO |
$116.56
|
|
|
HYDROMORPHONE 1 MG/ML INJ SYR
|
Facility
|
OP
|
$14.35
|
|
|
Service Code
|
HCPCS J1171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$14.21 |
| Rate for Payer: AlohaCare Medicaid |
$7.17
|
| Rate for Payer: AlohaCare Medicare |
$12.91
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: Devoted Health Medicare |
$14.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.63
|
| Rate for Payer: Health Management Network Commercial |
$12.20
|
| Rate for Payer: Humana Medicare |
$12.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.91
|
| Rate for Payer: MDX Hawaii PPO |
$13.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.91
|
| Rate for Payer: University Health Alliance Commercial |
$10.46
|
|
|
HYDROMORPHONE 1 MG/ML INJ SYR
|
Facility
|
IP
|
$14.35
|
|
|
Service Code
|
HCPCS J1171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$13.92 |
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: Health Management Network Commercial |
$12.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.91
|
| Rate for Payer: MDX Hawaii PPO |
$13.92
|
|
|
HYDROMORPHONE 2 MG PO TABLET
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: AlohaCare Medicaid |
$1.97
|
| Rate for Payer: AlohaCare Medicare |
$3.55
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Devoted Health Medicare |
$3.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network Commercial |
$3.35
|
| Rate for Payer: Humana Medicare |
$3.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.55
|
| Rate for Payer: MDX Hawaii PPO |
$3.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.55
|
| Rate for Payer: University Health Alliance Commercial |
$2.87
|
|
|
HYDROMORPHONE 2 MG PO TABLET
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Management Network Commercial |
$3.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.55
|
| Rate for Payer: MDX Hawaii PPO |
$3.82
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJ SYR
|
Facility
|
OP
|
$22.91
|
|
|
Service Code
|
HCPCS J1171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: AlohaCare Medicaid |
$11.46
|
| Rate for Payer: AlohaCare Medicare |
$20.62
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Devoted Health Medicare |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.76
|
| Rate for Payer: Health Management Network Commercial |
$19.47
|
| Rate for Payer: Humana Medicare |
$20.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.62
|
| Rate for Payer: MDX Hawaii PPO |
$22.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.62
|
| Rate for Payer: University Health Alliance Commercial |
$16.70
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJ SYR
|
Facility
|
IP
|
$22.91
|
|
|
Service Code
|
HCPCS J1171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$22.22 |
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Health Management Network Commercial |
$19.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.62
|
| Rate for Payer: MDX Hawaii PPO |
$22.22
|
|
|
HYDROXYCHLOROQUINE 200 MG PO TABLET
|
Facility
|
OP
|
$24.24
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: AlohaCare Medicaid |
$12.12
|
| Rate for Payer: AlohaCare Medicare |
$21.82
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Devoted Health Medicare |
$24.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.03
|
| Rate for Payer: Health Management Network Commercial |
$20.60
|
| Rate for Payer: Humana Medicare |
$21.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.82
|
| Rate for Payer: MDX Hawaii PPO |
$23.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.82
|
| Rate for Payer: University Health Alliance Commercial |
$17.67
|
|
|
HYDROXYCHLOROQUINE 200 MG PO TABLET
|
Facility
|
IP
|
$24.24
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$23.51 |
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Health Management Network Commercial |
$20.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.82
|
| Rate for Payer: MDX Hawaii PPO |
$23.51
|
|
|
HYDROXYZINE HCL 10 MG PO TABLET
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Health Management Network Commercial |
$1.30
|
| Rate for Payer: Health Management Network Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.23
|
| Rate for Payer: MDX Hawaii PPO |
$3.48
|
| Rate for Payer: MDX Hawaii PPO |
$1.48
|
|
